Girl Talk

Transgender voice therapy and what it means to sound like a woman

Lauren Lee had dressed with care that morning. She wore a sheer blue-and-white polka-dot blouse, blue jeans, and a thin gold chain around her neck. Her fingernails were tipped with red polish. A pair of wire-rimmed glasses and a delicate dusting of blue eyeshadow completed the look.

But she was more concerned at the moment with how she sounded. As an iPad listened from a nearby table, she read aloud a series of sentences from a sheet of paper before her. A white line streaked erratically across the screen with every syllable — skyward when her voice squeaked, back down when it deepened — as she tried to keep the pitch of her voice between 185 and 215 hertz.

When she failed, she closed her eyes, massaged her cheeks, and tried again. “My laptop needs to be charged,” she said, slowly and deliberately, the lines once more spiking up and down like a child’s drawing of a mountain range.

Lee had been coming to this dimly lit room, which barely fit three chairs, a table, and a motivational poster of children declaring, “We are communicating! We speak from our hearts! We understand!” twice a week for a year and a half. Shannon Hughes, a speech pathologist at the University of Connecticut’s Speech and Hearing Clinic, was her teacher. Hughes recorded Lee’s frequency from the iPad during every session, which began with vocal glides — oral glissandos that made Lee sound like an amateur opera singer — before transitioning to scripted sentences and improvised conversations. Throughout, Lee’s goal was to stay in her pitch range.

By the end of her training, the clinic promised, Lee — who presented as a man for fifty-three years before undergoing facial feminization surgery in September — would sound like a woman.

Vocal training is a step in gender transition that often goes unnoticed and unreported. Vanity Fair’s eleven-thousand-word account last June of Caitlyn Jenner’s transition from burly Olympian to sultry socialite contained seven mentions of her breasts, six of hormone therapy, three of her tracheal shave — also known as an Adam’s apple reduction — and zero of vocal training. Even the setting of voice therapy is more muted than the gleaming plastic surgeons’ offices in Boston and San Francisco where reassignment surgery often takes place. The Speech and Hearing clinic at UConn, where Lee went, is in a low, fluorescent-lit brick building in the rural town of Storrs, Connecticut, population eleven thousand.

Yet for many transgender people, sounding like their true gender is just as crucial to the transition process — and at times, just as complicated — as looking the part. What does it mean to sound like a woman, or to speak like a man?

Technically, the answer is simple: Male voices are usually deeper, produced by longer, thicker vocal cords that vibrate at frequencies between 85 and 180 hertz. Female voices are typically higher-pitched and usually fall between 165 and 255 hertz. But pitch is not the only determinant of a voice’s apparent masculinity or femininity. Resonance, which is how full a voice sounds, matters too — Lee’s falsetto, for instance, may be properly high-pitched, but it was often thin and unconvincing. According to Hughes, men also tend to speak in a more staccato style, whereas women are more fluid; men are louder, and women make more eye contact. Women use more hand movements than men, and they have a greater tendency to use so-called “tag words” at the end of sentences, right? These generalizations and stereotypes may be nothing more than that, but they play a significant role in shaping others’ perception of one’s voice.

Most transgender people who seek vocal therapy are males transitioning to female; unlike testosterone therapy, estrogen therapy does not affect the thickness of the vocal cords. Nothing short of surgery will shorten someone’s vocal cords — which is where the UConn clinic and others like it come in, teaching their clients techniques to sound more feminine.

The field of transgender voice therapy is still relatively new. Early literature emerged fifty years ago, but the field has gained momentum over the last two decades. Currently, there are about three dozen different locations across the country offering transgender voice therapy. One of the earliest such clinics opened in the mid-eighties, when Richard Adler, then a professor of speech and hearing science at Emory University, started a private practice at the request of Atlanta’s transgender population. The UConn clinic began offering transgender services five years ago, after an annual internal evaluation revealed that many transgender students on campus wanted such a program.

The stakes of sounding like one’s presented gender are high: Nineteen percent of transgender people have been refused medical care as a result of their gender identity, according to the National Center for Transgender Equality, and one percent have even been physically assaulted in emergency rooms. Twenty-one percent don’t tell their medical providers that they are transgender — an omission that cannot be sustained if their voice does not match their appearance. “If one day you’re in a car accident, and you’re lying in a hospital gurney and you look like a young woman but sound like a man, you’ll get discriminated against,” Lee said.

There are also smaller daily battles. Once, Lee said, a cashier called her “sir” when she ordered a snack at a restaurant. “I was wearing a skirt and a blouse, and they said, ‘Thank you, sir,’” she said. “That’s just kind of like a little punch in the gut when that happens.”

Lee was born in 1962 in Cleveland, Ohio as Terrence Lee, Terry for short. She knew before her fourth birthday that something didn’t feel right. When she was three, she was sent to her grandmother’s house during the birth of her younger sister. Lee hid in her grandmother’s closet and draped herself with earrings and necklaces. “I was afraid to death that my father would come through the door and catch me,” she said. “I knew that it was quote unquote wrong, that I shouldn’t be doing that because I’m a boy.”

Lee was especially close to her female cousin down the street, and always wanted to be doing whatever she was doing. At school, Lee enviously watched as girls played with dolls on the other side of the classroom, while she sat with the boys and halfheartedly joined sports teams at her father’s request. In college at Kent State, forced to live in an all-men’s dorm for two years, she said she was “horrified.” But she never told anyone how she felt. She hoped that one day she would wake up and her discomfort would be gone, that she would finally be happy in her body as a boy.

Just before college, Lee had begun piloting airplanes, following a childhood passion. In 1986, she joined the airline industry, and became a captain the following year. Her vow of silence solidified: Aviation was, and still is, a male-dominated industry. Back then, women held just .02 percent of pilot certificates; today, the number is just six percent. Lee saw her beloved profession as another reason to keep her long-held silence.

In 2013, Lee’s mother fell and broke her hip, then suffered a series of strokes. Lee returned to Cleveland from Providence, Rhode Island, where she had moved in the meantime, and split her time between the hospital and her childhood home. One day, she began flipping through old photo albums. “I could not find a single photo where I was smiling,” she said.

That October, Lee decided to see a gender therapist — not with the goal of transitioning, but as she put it, to find a way to “deal with it.” In spring 2014, she started hormone therapy and began attending sessions at the UConn speech clinic, about an hour from her home in West Greenwich, Rhode Island. At work, though, she still presented as man: A photo from June 2014 shows Lee in a pressed captain’s uniform, with closely cropped gray hair, wearing white iPod earphones and frowning into the camera.

As the months passed, Lee realized that the middle ground she’d been trying to navigate for the past fifty-three years would no longer suffice. She had three choices, as she put it: “transition, go crazy, or die.” In January 2015, she notified United Airlines of her gender transition. Eight months later, a plastic surgeon in Boston cut back Lee’s jawbone, inserted cheek implants, and peeled back her forehead to sand down the strong brow bone that is characteristic of male faces. The procedure lasted eight-and-a-half hours.

When Lee returned to work in November, the stern, lock-jawed Captain Terry from the photo was gone. In his place was Captain Lauren, the first transgender captain who was not immediately grounded by the Federal Aviation Administration following a gender transition. This January, the FAA announced it will no longer classify transgender pilots as having a disorder, paving the way for countless other transgender pilots.

As much as Lee focused on her pitch, as the old urban legend goes, over ninety percent of communication is nonverbal. So Hughes spent just as time training Lee to hold her hands close to her body, as women do, or to nod to show that she’s listening, as she did helping Lee adjust her pitch.

But this training strikes at the heart of debates about the definition of femininity, which have engrossed feminists for decades. Some of the cues the clinic teaches, like the proper form for hand gesturing, are more or less inoffensive. But others, like the directive to imbue sentences with a singsong quality, have generated more pause, for what some say is their role in reinforcing sexist gender stereotypes. Wendy Chase, the clinic’s director, raised this in an interview with the Associated Press: “There is tremendous irony in the fact that we use information based on stereotype to make people feel better about themselves,” Chase said. “But that’s what we do.”

Indeed, many of the techniques that the clinic’s speech therapists teach their transgender clients to help them pass as more feminine are behaviors that have been used to label women as unassertive, insecure, or silly. Journalist Jessica Grose, while hosting a podcast for Slate, said she often received emails from listeners criticizing her female “upspeak” and “vocal fry” — ending sentences on a higher pitch or drawing out the ends of sentences, respectively. Listeners said they made her sound unauthoritative. In 2014, Fortuneurged female professionals to “avoid squeak” if they wanted to be taken seriously. And when Hughes instructed Lee to begin sentences with “um” as a tool for self-calibration, Lee’s responses couldn’t help but take on the apparent uncertainty that has been used to caricature women’s speech.

In other words, the clinic uses gender stereotypes to train a group that is already, by definition pushing back on stereotypes of what it means to belong to a certain gender. When asked about this tension, Chase laughed. “Because society has already determined how it feels about gender identity, and the mannerisms that go along with that, by buying into some of those stereotypes, someone can feel more comfortable not being misgendered,” she said. “We don’t use those stereotypes because we agree with them. We use them because the research supports that people who can pass more easily by using some of these characteristics are more satisfied.”

Questions about embodying stereotypes about women have continued to plague Caitlyn Jenner, whom many have hailed as the harbinger of mainstream acceptance of the transgender community. After Jenner made her tightly-corseted appearance in Vanity Fair, transgender actress Laverne Cox praised Jenner’s courage but gently reminded fans that descriptions of both Jenner’s and Cox’s own beauty revolve around their ability “in certain lighting, at certain angles…[to] embody certain cisnormative beauty standards.” PBS news anchor Gwen Ifill was more blunt, tweeting, “Let me get this right. Asserting one’s femininity means posing in a low cut swimsuit. Ok. Got it.”

Several months later, after Jenner told BuzzFeed that the hardest part of being a woman is “figuring out what to wear,” actress Rose McGowan wrote an open letter telling Jenner that women are “more than the stereotypes foisted upon us by people like you.” And after Jenner told Diane Sawyer last April that her brain “is much more female than it is male,” feminist scholar and documentary filmmaker Elinor Burkett penned a blistering opinion piece in the New York Timesblasting Jenner for suggesting that gender is simply a matter of neurological processes. “By defining womanhood the way he did,” Burkett wrote, “Mr. Jenner and the many advocates for transgender rights who take a similar tack…undermine almost a century of hard-fought arguments that the very definition of female is a social construct that has subordinated us.”

Lee, for her part, is unfazed by this. For her, there is no tension between her learned behavior and her gender nonconformity, because she has known her true gender identity her entire life; the clinic’s training was not so much about adopting new mannerisms as it was about allowing herself to embrace long-suppressed ones. “I used to catch myself doing female-type things, like standing with my legs crossed and my hip out, or stand with my hand on my hip. My father would nudge me and say, ‘Boys don’t do that,’” she said. “A very hard part now is stopping censoring myself and allowing that stuff to happen.”

After Lee finished reading the sentences she moved on to her improvisation exercises, which challenged her to keep her voice in range without focusing on it exclusively. Hughes read off a number of prompts — list three steps you should take before a job interview, describe an airport farewell scene — and Lee made up answers. “You see two people standing outside. One of them gets in the car, slams the door, and speeds away. The other person is still standing there crying. What just happened?”

“Um, it was probably an argument that led to a breakup of some kind.” Lee paused. The intentional “ums” mixed with unintentional ones as she became flustered. “I don’t know. A business deal gone bad? A romance gone bad?” The words tumbled out of her mouth, getting thin and reedy before plummeting into a fuller, but much lower, tenor. She cut herself off.

Hughes changed tactics. “Why don’t you give me three sentences you might say to your passengers?” she asked. “Ladies and gentlemen, the fasten seatbelt sign has been turned on,” Lee recited. “Please return to your seats and make sure your seatbelts are securely fastened.” Lee’s pitch stabilized into a smooth, confident alto. “Look how nice that is,” Hughes said. “Let’s practice that one again, because you’re going to use that a lot.”

During Lee’s twenty-eight years as Captain Terry, she often purposely deepened her already gravelly tenor to sound as authoritative as possible, and to reaffirm, either to herself or to her passengers, her own maleness. She dropped her voice to demonstrate, and the sound was startling in its deep, rich tones and the ease with which it emerged from her throat.

Now, even though Lee is Captain Lauren, her passengers do not see her new blonde bob or meticulously painted red fingernails. They don’t see how she holds her hands in close to her body. They only hear her voice over the intercom, and when she announces that the plane’s landing into Chicago will be delayed by half an hour, she wants to sound unmistakably female.

For this reason, Lee’s target range was actually quite a bit higher than the frequency that would acceptably pass as female. If she accomplished it, her voice would actually be twenty hertz higher than Hughes’.

In March 2015, CNN published an article about trailblazing female airline captains. While the number of female pilots has grown slowly but steadily over the decades, the number of female captains — pilots who are in charge of the rest of the on-flight crew — remains at an astonishingly low at four hundred and fifty worldwide. Lee came across the article recently and sent it to one of her friends who is one of the four-fifty, to congratulate her on being among the elite. “She texted back, ‘Lauren, welcome to the club,’” Lee said. “But I don’t really feel how much I belong to that club. Nobody ever questioned if I could be a pilot, if I was smart enough, strong enough.”

Lee recognizes that as fraught with challenges as her life has been, it has not, until recently, been fraught with specifically female ones. But now, she is content, even eager, to embrace society’s feminine norms, the good and the bad — whether that means painting her nails bright red or speaking in a higher pitch, as she discovers what it means to live as a woman, collecting the social experiences whose absence Burkett and other critics say make transgender women incapable of understanding true womanhood. After all, cisgender women aren’t born with their “female” experiences either; they accumulate them, through years and years of making their way through society while being seen as women.

“I’m not looking to set the world on fire,” Lee said. “I know I’m never going to be an attractive woman, or a desirable woman; I started at an age when it’s just not going to happen. I just want to live my life without being questioned. If people perceive me as a woman, period, that’s what I need. That’s all I need.”

In April, after two years of vocal training, Lee went under the knife once more, this time for the vocal surgery she had been hoping to avoid by attending the clinic. The training wasn’t enough, and she didn’t want any more anxiety about her voice. Lee once described being transgender as being stuck in a room with a very loud machine grinding away in the background. Certain things, like flying, distracted her from the noise temporarily, but it was always there.

As she began her gender transition, the noise began to diminish: a little bit with hormone therapy, a little bit more with her surgery. Voice therapy helped quiet it further, vocal surgery even more. Maybe one day it will be gone. And now in its place, there is a new noise, one she’s making for herself — just a little higher than before.